The current state of melanoma detection with algorithm-based and dermatologist-based smartphone applications: Towards improved healthcare access in

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1 The current state of melanoma detection with algorithm-based and dermatologist-based smartphone applications: Towards improved healthcare access in the Hawaiian Islands Michael Tee MD, PhD University of Hawaii April 4, 2019

2 Disclosures No financial disclosures

3 Outline Skin cancer Hawaiian Islands Aim Method Results Summary Current state of implementation Take home points

4 Introduction: Skin cancer Main types: Basal, Squamous, Melanoma the incidence of skin cancer (in Aus) is one of the highest in the world two to three times the rates in Canada, the US and the UK 5.4 million cases (US) NMSC, 959,243 (Aus) 96,480 (US) new melanomas, 15,229 (Aus) 7,230 people (US) die of melanoma, 1,725 (Aus) Merkel cell cancer 2000 a year *SEER = Surveillance, Epidemiology, and End Results American Cancer Society

5 Hawaiian Islands

6 Hawaiian Islands Island, Population, Dermatologist, 2018 Oahu 943, Hawaii 186,738 2 Maui 144, Kauai 66,921 1 Molokai 7,345 none Lauai 3,135 none Niihau 170 none Kahoolawe (unpopulated) none

7 Aim: Access to dermatological expertise Hawaiian Islands geography greatly encourages the use of virtual care Meaningfully embed virtual care into clinical care

8 Aim: Access to dermatological expertise Via smartphone applications 43 dermatological apps related to melanoma detection in 2018 Teledermatology store-and-forward platforms Dermatologist-based (DB) mobile examination Internal algorithm-based (AB) apps

9 Method Meta-analysis to assess the association between melanoma detection and smartphone screening. comprehensive literature review through December case-control and cross-sectional studies that compared the detection abilities of melanomas with smartphones compared to face-to-face (FTF) dermatologist screening with histopathological diagnoses confirmation. calculated pooled odds-ratio (OR) with 95% confidence intervals (CI) and I 2 statistics using a random effect model.

10 Results Nine studies with sixteen smartphone apps Favors no melanoma detection benefit compared to FTF Favors melanoma detection benefit compared to FTF

11 Summary FTF examinations are still superior to both the current AB and DB apps. As algorithms and processes improve, continued scrutiny and transparency is needed.

12 Applications in the Hawaiian Island Little to no uptake

13 Take Home Points Much work to be done before implementation in Hawaii s healthcare system Quality verification issues Reimbursement issue Integration, usability Access issues continue to be an issue

14 References 1.Ngoo, A., Finnane, A., McMeniman, E., Soyer, H. P. & Janda, M. Fighting Melanoma with Smartphones: A Snapshot of Where We are a Decade after App Stores Opened Their Doors. Int. J. Med. Inf. 118, (2018). 2. Dorairaj, J. J., Healy, G. M., McInerney, A. & Hussey, A. J. Validation of a Melanoma Risk Assessment Smartphone Application: Dermatol. Surg. 43, (2017). 3. Maier, T. et al. Accuracy of a smartphone application using fractal image analysis of pigmented moles compared to clinical diagnosis and histological result. J. Eur. Acad. Dermatol. Venereol. 29, (2015). 4. Kroemer, S. et al. Mobile teledermatology for skin tumour screening: diagnostic accuracy of clinical and dermoscopic image tele-evaluation using cellular phones: Mobile teledermatology for skin tumour surveillance. Br. J. Dermatol. 164, (2011). 5. Boyce, Z., Gilmore, S., Xu, C. & Soyer, H. P. The Remote Assessment of Melanocytic Skin Lesions: A Viable Alternative to Face-to-Face Consultation. Dermatology 223, (2011). 6. Börve, A., Terstappen, K., Sandberg, C. & Paoli, J. Mobile teledermoscopy there s an app for that! Dermatol. Pract. Concept. 3, (2013). 7. Börve, A. et al. Smartphone Teledermoscopy Referrals: A Novel Process for Improved Triage of Skin Cancer Patients. Acta Derm. Venereol. 95, (2015). 8. Wolf, J. A. et al. Diagnostic Inaccuracy of Smartphone Applications for Melanoma Detection. JAMA Dermatol. 149, 422 (2013). 9. Chadwick, X., Loescher, L. J., Janda, M. & Soyer, H. P. Mobile Medical Applications for Melanoma Risk Assessment: False Assurance or Valuable Tool? in th Hawaii International Conference on System Sciences (IEEE, 2014). doi: /hicss Ngoo, A. et al. Efficacy of smartphone applications in high-risk pigmented lesions. Australas. J. Dermatol. 59, e175 e182 (2018).

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